Kristy Smetak
Flushing,NY
Summary
Detail-oriented and experienced Medical Billing and Coding Specialist with 6.5 years of expertise in medical coding, billing, and revenue cycle management. Proficient in ICD-10-CM, CPT, and HCPCS coding with a strong track record of handling complex claims, managing appeals, and ensuring regulatory compliance. Adept at optimizing billing processes, enhancing team performance, and delivering exceptional patient and provider support. Seeking to advance my career in a dynamic environment where I can further develop my skills and contribute to efficient and accurate medical billing and coding operations.
Overview
10
10
years of professional experience
Work History
Medical Billing &Coding Manager
MedPro Systems INC
01.2021 - Current
- Oversaw Payment Processing: Directed the accurate posting and reconciliation of payments, ensuring timely and correct updates to accounts receivable.
- Managed Appeals: Developed and implemented strategies for processing and resolving claim denials, enhancing the rate of successful appeal outcomes.
- Applied Advanced Coding: Utilized ICD-10-CM and CPT codes for detailed medical case coding, ensuring precision and compliance with healthcare billing standards.
- Supervised Billing Operations: Led the billing and coding department, overseeing daily operations to ensure efficiency, accuracy, and adherence to policies.
- Engaged with Providers: Communicated with healthcare providers to discuss revenue cycle performance, address billing issues, and improve overall claim resolution.
- Ensured Regulatory Compliance: Monitored and enforced compliance with coding guidelines, payer requirements, and industry regulations to maintain billing integrity and avoid audit issues.
- Optimized Processes: Identified and implemented process improvements to enhance billing accuracy, reduce claim denials, and streamline operations.
- Trained and Mentored Staff: Provided training and guidance to billing and coding staff, fostering skill development and improving departmental performance.
Medical Billing & Coding Specialist
Pure Health Management
10.2018 - 01.2021
- Processed Claims: Accurately submitted and followed up on medical claims to insurance companies, ensuring timely and correct reimbursement.
- Managed Patient Accounts: Updated and maintained patient accounts, including verifying insurance information and managing billing records.
- Applied Codes: Utilized ICD-10-CM and CPT codes for medical services and procedures, ensuring correct and compliant coding practices.
- Handled Payments: Posted and reconciled payments and adjustments to patient accounts, ensuring accuracy and resolving discrepancies.
- Resolved Billing Issues: Addressed and resolved billing inquiries and discrepancies from patients and insurance companies, facilitating smooth claim processing.
- Maintained Records: Kept detailed and organized records of claims, payments, and patient communications to ensure data accuracy and compliance.
- Supported Compliance: Followed coding guidelines and regulatory requirements to ensure billing practices adhered to industry standards.
Medical Assistant
Sure Medical Care PC
01.2015 - 12.2017
- Phlebotomy: Proficient in drawing blood using venipuncture techniques, ensuring patient comfort and safety. Skilled in labeling, storing, and preparing samples for laboratory analysis.
- EKG Administration: Experienced in performing electrocardiograms (EKGs) to monitor heart function, including proper lead placement, patient preparation, and result documentation.
- Flu Testing & Immunizations: Conduct flu tests and administer vaccinations following proper procedures, maintaining strict adherence to infection control and safety protocols.
- Patient Care & Assessment: Assist in patient intake, including vital signs, medical history, and symptom documentation. Provide patient education on procedures and follow-up care.
- Clinical Procedures: Support physicians with minor surgical procedures, wound care, and other clinical tasks, ensuring sterile environments and proper equipment handling.
- Medical Office Support: Manage patient flow, schedule appointments, handle medical records, and communicate effectively with patients, physicians, and staff to ensure efficient office operations.
- Electronic Health Records (EHR): Experienced in documenting patient information and treatment plans in EHR systems, ensuring accuracy and confidentiality.
- Infection Control & Safety: Maintain a clean and safe clinical environment by adhering to OSHA standards and office protocols, including proper disposal of biohazard materials.
Education
Associate of Applied Science - Health Information Technology
Plaza College
Forest Hills, NY06.2020
Certification - Outpatient Ambulatory Medical Coding/Billing
The Roxbury Institute of Medical Management
Jamaica, NY12.2016
Skills
- ICD-10-CM, CPT Coding
- Claims Processing & Appeals
- Regulatory Compliance
- Revenue Cycle Management
- Data Analysis
- Team Leadership
- Problem-Solving
- Effective Communication
- Attention to Detail
- EHR & Billing Software
- Customer Service
- Process Improvement
Certifications
- American Academy of Professional Coders, Certified Professional Coder (CPC) # 01510125, 11/2017
Timeline
Medical Billing &Coding Manager
MedPro Systems INC
01.2021 - Current
Medical Billing & Coding Specialist
Pure Health Management
10.2018 - 01.2021
Medical Assistant
Sure Medical Care PC
01.2015 - 12.2017
Associate of Applied Science - Health Information Technology
Plaza College
Certification - Outpatient Ambulatory Medical Coding/Billing
The Roxbury Institute of Medical Management
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